Anticoagulation control in a standard of care versus a pharmacist-managed warfarin monitoring service at Windhoek Central Hospital, Namibia

dc.contributor.advisorVerbeeck, Roger
dc.contributor.authorThikukutu, Moses Mukwipure
dc.date.accessioned2025-01-31T13:30:26Z
dc.date.available2025-01-31T13:30:26Z
dc.date.issued2024
dc.descriptionA thesis submitted in fulfillment of the requirements for the Degree of Master of Pharmacy in Clinical Pharmacy
dc.description.abstractIntroduction: Warfarin remains the drug of choice for treating thromboembolic diseases in Namibia. A historical control study reported a patient’s mean time in the therapeutic range (TTR) at the Warfarin Outpatient Clinic of Windhoek Central Hospital (WCH) to be suboptimal (29.4%). Interventions to improve anticoagulation control were instituted and they involved a pharmacist-directed warfarin therapy. The main objective was to improve anticoagulation control in the intervention group and compare it to the historical control group. Methods: A prospective cohort design was used. Adult patients who attended the warfarin clinic on Wednesdays and gave consent were exposed to the intervention study. The main outcome measure was the TTR computed using the Rosendaal method. Binary logistic regression was used to identify factors associated with poor anticoagulation control. A between groups comparison of anticoagulation control was based on the paired and unpaired patient cases. A p value < 0.05 was considered statistically significant. Results: A total of 330 patients were part of the present study (control (215) and intervention (115)). The majority (63.4%) of the patients in the intervention group were females. The mean (± SD) age was 45 ± 17 years. The top three prevalent clinical indications for warfarin in the intervention study were deep vein thrombosis (49.6%), mitral valve replacement (13.9%), and pulmonary embolism (13%). Only the baseline INR (OR 0.34 [95%CI: 0.13-0.86]) and warfarin dosage adherence (OR 0.17 [95%CI: 0.04-0.84]) were significant predictors of good anticoagulation control in the intervention group. The Mann-Whitney U test showed an 18% (p<0.050) improvement in the median %TTR when the unpaired cases between the groups were compared. The paired t-test showed a 10% (p=0.220) improvement in the mean %TTR when the paired patient cases between the groups were compared. Conclusion: Interventions involving a pharmacist-directed warfarin therapy were associated with improved anticoagulation control at the WCH warfarin clinic. Baseline INR and warfarin dosage adherence were statistically significant predictors of good anticoagulation control
dc.identifier.urihttp://hdl.handle.net/11070/3933
dc.language.isoen
dc.publisherUniversity of Namibia
dc.subjectWarfarin
dc.subjectAnticoagulation
dc.subjectTime in therapeutic Range
dc.subjectPharmacist
dc.subjectUniversity of Namibia
dc.subjectNamibia
dc.titleAnticoagulation control in a standard of care versus a pharmacist-managed warfarin monitoring service at Windhoek Central Hospital, Namibia
dc.typeThesis
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